Stories from a NZ Paramedic

I wrote an autobiography about my time as a frontline Paramedic. This blog shares some of the stories from the frontline

Thursday, May 26, 2016

My experience as a patient

It seemed like just another
Monday night. Standing in a cool winter breeze under a light drizzle I was
waiting for the player of the day award to be announced at my eight year old daughters’
hockey game, when I suddenly felt that uncomfortable sinking feeling in my
chest. My heart skipped a beat and was suddenly beating irregularly.

It’s always an uncomfortable feeling,
but initially I wasn’t too worried, as previous episodes had only lasted
seconds, and I knew I was prone to them when I was tired, dehydrated and had
recently drunk coffee. Tonight all three criteria were in play so, it wasn’t
surprising my heart was rebelling to my poor dietary choices. Previous runs had
lasted just seconds before self-reverting and I was hoping like hell this would
be the same. Unfortunately, it wasn’t to be.

My daughter didn’t receive
player of the day, even though she totally deserved it. The award had to be
shared around and she received it the first game. Now she was begging me to go
get some hot chips from the café which was the last thing I wanted to do. The
palpitations were still happening and I was now becoming increasingly anxious,
as my usual tricks of gulping down copious amounts of water and trying a covert
Valsalva manoeuvre had failed to stop the irregular beats. I snapped at her and
said we needed to get going.

As we walked to the car I was silently trying to work out how serious this was and whether I should drive home,
drive straight to the hospital, ring my wife to come get us, or call an
ambulance. Fortunately the palpitations, although uncomfortable, were not
causing any major problems. I had no chest pain, I wasn’t overly short of
breath (although the anxiety did make me feel that way), and I wasn’t light
headed or dizzy. I decided on the first option and headed home to reassess the situation. We made it
home safely and I did my best to explain the situation to my now very concerned wife.

After attempting further
Valsalva manoeuvres and drinking iced water, I decided it was time to seek
help. My clinical training meant I was well aware of the complications arrhythmia's can
cause, including stroke or even cardiac arrest. I dissolved and swallowed down
an Aspirin and made the call I needed to make and then waited nervously for help to arrive.

It is always a little
disconcerting when you have to ask your colleagues for help. I had no idea who
would show up or what their reaction would be. All I knew was that I needed to
see my rhythm on a monitor and decide on the next course of action.

The vehicle soon pulled up
outside my house and I walked into the ambulance to greet the surprised crew
and explain my predicament to them.

Fortunately I knew one of the
paramedics and after explaining the situation they awkwardly attached me to the
monitor and printed out an ecg strip for me. As an ICP and University lecturer,
I understood they may have felt intimidated treating me, so I tried to keep it
light-hearted and disguise the internal anxiety I was feeling with some
external smiles and light humour.

The 12 lead ecg confirmed I
was in a rapid and irregular atrial fibrillation (AF) rhythm with a ventricular
response of around 150 beats per minute. I then asked the crew to please insert
an intravenous line into my arm and to give me some fluids. Dehydration can precipitate
tachydysrythmias and I personally have had around a seventy percent success
rate at reverting patients in these rhythms with fluids alone, so it was worth
a shot.

My wife and kids had popped into
the ambulance to see me so I tried to make light of the situation and explain
everything was going to be fine and that I would likely be home that night.
Ironically this was the only reassurance that was uttered during the entire
experience that night.

Inside the ambulance. Smiles outside, freaking out on the inside

The crew were friendly and did
most of the things they were supposed to do during the short trip and it wasn’t long before I was walking
into the Ambulance bay of the Emergency Department, waiting to be seen by the
triage nurse.

There was a female patient in
the isolation room that adjoins the bay and she was nutting off, shouting out threatening
expletives and obscenities to the psychiatric team that were trying to deal
with her. Just hearing her scream and yell made my anxiety shoot up a notch or two and my heart skipped a few more beats.

I was soon triaged appropriately
and sent through to a monitoring room, thankfully towards the back of the
department. The thought of seeing all my colleagues walk past me and stopping
to find out what had happened was not a thrilling prospect.

I got to my assigned bed in a
monitoring cubicle and waited for a nurse to come along. At least lying semi
reclined on a hospital bed felt a little better, although my rate had not
subsided at all. I started firing off texts to my boss, family and friends
letting them know of my predicament.

After ten or so minutes a
nurse came and introduced herself and gave me the compulsory, but ugly and awkward, hospital gown
to put on. The litre of IV fluid was now well on board so when she left I
quickly shot off to the toilet to vacate my bladder which was now ready to burst its banks.
By the time I came back she had the monitor turned on and was ready to hook me
up. With a stern face she told me that if I needed to go again, I needed to use the urinal, especially
with a heart rate of between 140 and 160 beats, which the monitor was now colorfully showing.

The nurse was actually very pleasant
and thorough, and took all the usual baselines, drew blood samples and made
small talk in-between writing down her findings. She then took the chart away
and informed me the doctor would review the ecg and come and see me sometime soon. Although
polite and professional, she didn’t mention the words I was waiting for – that
everything was going to be ok.

Meanwhile I was researching
all I could about AF. Causes, cures and treatments. Dr Google was continuously presenting
cardioversion as being a treatment option which was rather disconcerting.
This would involve being sedated and a synchronous shock being delivered from a
defibrillator to try and stun my heart back to a normal rhythm. We only administer this for seriously compromised cases so I decided I
would not opt for that treatment should it ever be offered. The reassuring
thing, however, was that according to most of the clinical literature I could
actually find, AF seemed to spontaneously self-revert within 24 hours in the majority of
acute cases. I decided that I was going to be one of those cases. It was time for
some positive mental affirmations.

The IV fluid the ambulance
crew gave me was sure doing its job and I was onto filling my second cardboard urinal
already. As I stood up to awkwardly pee into the fragile container, I suddenly felt my
palpitations stop and my heart resume into a normal rythm. I looked up at the monitor, and to my delight, I
had self-reverted back into a sinus rhythm, although it was still a little fast
at 115 beats per minute. I lay back on the bed with a sigh of relief as the
anxiety left me for good.

Suddenly, a visitor pulled back
the cubicle curtain and popped his head in. Tony, my boss, had made a surprise
visit to come and see me. It was a welcome relief to have someone familiar to
chat to, especially when they are also a clinician. We spoke about our work and
my condition and he told me to call if I needed anything. With my wife stuck at home with my two young children in bed, his visit was the boost
to my morale that I desperately needed and I genuinely thanked him for taking
time to pop in. I doubt he realises even to this day what a positive impact his
short visit had.

After Tony’s visit, the doctor
came in next and introduced herself. I gave her the history and explained I had
just self-reverted about twenty minutes ago. She did her examination and said
she would check the bloods, ecg, chat to the cardiologist and decide on a plan.
Although pleasant and professional there were still no words of reassurance, not
one, although the condition had normalised.

Shift change came around and a
new nurse introduced himself. Apparently the blood results showed I was
slightly dehydrated and slightly low in potassium so he gave me a fizzy drink
with potassium to gulp down and attached another litre of saline to my IV.
Given that my heart rate was now slowing down, I didn’t really mind what he did. I
was finally starting to relax and fired off some more texts to let everyone
know I was now ok. I even managed a few selfies in between reading a magazine
article.

Second bag of fluid running after reverting to NSR

After another twenty minutes
the doctor returned and gave me the all clear. Bloods were back to normal and
the ECG had normalised too. She kindly gave me discharge notes and copies of my
ECG’s and said my risk factor for stroke was zero which was great news. Four
and a half hours after being admitted, I was finally free to go. After
painfully removing the ECG electrodes, along with a decent amount of chest
hair, I headed home.

Being a patient was a sobering
experience for me. For someone who has operated on the other side as a
clinician, it was both educational and insightful.

As a lecturer, I teach my
first year paramedic students that reassurance is a vital part of the treatment
process. Our patients are literally hanging out for us to utter those magic words
– “things are going to be ok”. It is a fundamental principle we learn as
children, when a hug from mum or dad cured any amount of anxiety, or injury and
although it’s not necessary to hug our patients, uttering that simple sentence
can make a world of difference. Despite being a clinician, as a patient I felt
vulnerable and those words would have reduced my anxiety and my heart rate, had
they been uttered by any of the clinicians that treated me.

I have made a vow to ensure I
continue to reassure my patients and also their relatives, explaining the
medical condition, providing options for treatment and reinforcing any positive
baselines that I record. I will also ensure I shave hairy chests before
attaching ECG electrodes, as removing them was the most painful part of the
entire experience.

Finally, I bought myself a
large drink bottle and will make it gospel to drink at least two of those each
day. Despite the great insight, I much prefer to stay on the clinical side of
the patient fence.

About Me

Paramedic Lecturer, Qualified Ambulance and Offshore/remote Intensive Care Paramedic for 17+ years. Have written a book about my experiences called Priority One which is now available to download from Amazon.com or by selecting from the widget below.